Category: media

Just a few years ago, the onslaught of digital books seemed unstoppable. Sales of electronic books (E-books) were surging, people were extolling the convenience of carrying around a whole library of thousands of books on a portable digital tablet, phones or E-book readers such as the Amazon Kindle. In addition to portability, E-books allow for highlighting and annotating of key sections, searching for keywords and names of characters, even looking up unknown vocabulary with a single touch. It seemed only like a matter of time until E-books would more or less wholly replace old-fashioned physical books. But recent data seems to challenge this notion. A Pew survey released in 2016 on the reading habits of Americans shows that E-book reading may have reached a plateau in recent years and there is no evidence pointing towards the anticipated extinction of physical books.

The researchers Ozgun Atasoy and Carey Morewedge from Boston University recently conducted a study which suggests that one reason for the stifled E-book market share growth may be that consumers simply value physical goods more than digital goods. In a series of experiments, they tested how much consumers value equivalent physical and digital items such as physical photographs and digital photographs or physical books and digital books. They also asked participants in their studies questions which allowed them to infer some of the psychological motivations that would explain the differences in values.

In one experiment, a research assistant dressed up in a Paul Revere costume asked tourists visiting Old North Church in Boston whether they would like to have their photo taken with the Paul Revere impersonator and keep the photo as a souvenir of the visit. Eighty-six tourists (average age 40 years) volunteered and were informed that they would be asked to donate money to a foundation maintaining the building. The donation could be as low as $0, and the volunteers were randomly assigned to either receiving a physical photo or a digital photo. Participants in both groups received their photo within minutes of the photo being taken, either as an instant-printed photograph or an emailed digital photograph. It turned out that the participants randomly assigned to the digital photo group donated significantly less money than those in the physical photo group (median of $1 in the digital group, $3 in the physical group).

In fact, approximately half the participants in the digital group decided to donate no money. Interestingly, the researchers also asked the participants to estimate the cost of making the photo (such as the costs of the Paul Revere costume and other materials as well as paying the photographer). Both groups estimated the cost around $3 per photo, but despite this estimate, the group receiving digital photos was much less likely to donate money, suggesting that they valued their digital souvenir less.

In a different experiment, the researchers recruited volunteer subjects (100 subjects, mean age 33) online using a web-based survey in which they asked participants how much they would be willing to pay for a physical or digital copy of either a book such as Harry Potter and the Sorcerer’s Stone (print-version or the Kindle E-book version) or a movie such as The Dark Knight (DVD or the iTunes digital version). Participants were also asked how much “personal ownership” they would feel for the digital versus the corresponding physical items by completing a questionnaire scored with responses ranging from “strongly agree” to “strongly disagree” to statements such as “feel like it is mine”. In addition to these ownership questions, they also indicated how much they thought they would enjoy the digital and physical versions.

The participants were willing to pay significantly more for the physical book and physical DVD than for the digital counterparts even though they estimated that the enjoyment of either version would be similar. It turned out that participants also felt a significantly stronger sense of personal ownership when it came to the physical items and that the extent of personal ownership correlated nicely with the amount they were willing to pay.

To assess whether a greater sense of personal ownership and control over the physical goods was a central factor in explaining the higher value, the researchers than conducted another experiment in which participants (275 undergraduate students, mean age of 20) were given a hypothetical scenario in which they were asked how much they would be willing to pay for either purchasing or renting textbooks in their digital and print formats. The researchers surmised that if ownership of a physical item was a key factor in explaining the higher value, then there should not be much of a difference between the estimated values of physical and digital textbook rentals. You do not “own” or “control” a book if you are merely renting it because you will have to give it up at the end of the rental period anyway. The data confirmed the hypothesis. For digital textbooks, participants were willing to pay the same price for a rental or a purchase (roughly $45), whereas they would pay nearly twice that for purchasing a physical textbook ($88). Renting a physical textbook was valued at around $59, much closer to the amount the participants would have paid for the digital versions.

This research study raises important new aspects for the digital economy by establishing that consumers likely value physical items higher and by also providing some insights into the underlying psychology. Sure, some of us may like physical books because of the tactile sensation of thumbing through pages or being able to elegantly display are books in a bookshelf. But the question of ownership and control is also an important point. If you purchase an E-book using the Amazon Kindle system, you cannot give it away as a present or sell it once you are done, and the rules for how to lend it to others are dictated by the Kindle platform. Even potential concerns about truly “owning” an E-book are not unfounded as became apparent during the infamous “1984” E-book scandal, when Amazon deleted purchased copies of the book – ironically George Orwell’s classic which decries Big Brother controlling information –from the E-book readers of its customers because of some copyright infringement issues. Even though the digital copies of 1984 had been purchased, Amazon still controlled access to the books.

Digital goods have made life more convenient and also bring with them collateral benefits such as environment-friendly reduction in paper consumption. However, some of the issues of control and ownership associated with digital goods need to be addressed to build more trust among consumers to gain more widespread usage.

The Affordable Care Act, also known as the “Patient Protection and Affordable Care Act”, “Obamacare” or the ACA, is a comprehensive healthcare reform law enacted in March 2010 which profoundly changed healthcare in the United States. This reform allowed millions of previously uninsured Americans to gain health insurance by establishing several new measures, including the expansion of the federal Medicaid health insurance coverage program, introducing the rule that patients with pre-existing illnesses could no longer be rejected or overcharged by health insurance companies, and by allowing dependents to remain on their parents’ health insurance plan until the age of 26. The widespread increase in health insurance coverage – especially for vulnerable Americans who were unemployed, underemployed or worked for employers that did not provide health insurance benefits – was also accompanied by new regulations targeting the healthcare system itself. Healthcare providers and hospitals were provided with financial incentives to introduce electronic medical records and healthcare quality metrics.

As someone who grew up in Germany where health insurance coverage is guaranteed for everyone, I assumed that over time, the vast majority of Americans would appreciate the benefits of universal coverage. One no longer has to fear financial bankruptcy as a consequence of a major illness and a government-back health insurance also provides for peace of mind when changing jobs. Instead of accepting employment primarily because it offers health benefits, one can instead choose a job based on the nature of the work. But I was surprised to see the profound antipathy towards this new law, especially among Americans who identified themselves as conservatives or Republicans, even if they were potential beneficiaries of the reform. Was the hatred of progressive-liberal views, the Democrats and President Obama who had passed the ACA so intense among Republicans that they were willing to relinquish the benefits of universal health coverage for the sake of their political ideology? Or were they simply not aware of the actual content of the law and opposed it simply for political reasons?

A recent study published by a team of researchers led by Sarah Gollust at the University of Minnesota may shed some light on this question. Gollust and her colleagues analyzed 1,569 local evening television news stories related to the ACA that were aired in the United States during the early months of when the health care reform was rolled out (between October 1, 2013, and April 19, 2014). They focused on analyzing local television news broadcasts because these continue to constitute the primary source of news for Americans, especially for those who are age 50 and higher. A Pew survey recently showed that 57% of all U.S. adults rely on television for their news, and among this group, local TV new (46%) is a more common source than cable news (31%) or network news (30%).

Gollust and colleagues found that 55% of the news stories either focused on the politics of the ACA such as political disagreements over its implementation (26.5%) or combined information regarding its politics with information on how it would affect healthcare insurance options (28.6%). Only 45% of the news stories focused exclusively on the healthcare insurance options provided by the law. The politics-focused news stories were also more likely to refer to the law as “Obamacare” whereas healthcare insurance focused news segments used the official name “Affordable Care Act” or “ACA”. Surprisingly, the expansion of Medicaid, which was one of the cornerstones of the ACA because it would increase the potential access to health insurance for millions of Americans, was often ignored. Only 7.4% of news stories mentioned Medicaid at all, and only 5% had a Medicaid focus.

What were the sources of information used for the news stories? President Obama was cited in nearly 40% of the stories, whereas other sources included White House staff or other federal executive agencies (28.7%), Republican (22.3%) or Democratic (15.9%) politicians and officials. Researchers, academics or members of think tanks and foundations were cited in only 3.9% of the news stories about the ACA even though they could have provided important scholarly insights about the ACA and its consequences for individual healthcare as well as the healthcare system in general.

The study by Gollust and colleagues has its limitations. It did not analyze TV network news, cable news, or online news outlets which have significantly gained in importance as news sources during the past decade. The researchers also did not analyze news stories aired after April 2014 which may have been a better reflection of initial experiences of previously uninsured individuals who signed up for health insurance through the mechanisms provided by the ACA. Despite these limitations, the study suggests that one major reason for the strong opposition among Republicans against the ACA may have been the fact that it was often framed in a political context and understated the profound effects that the ACA had on access to healthcare and the reform of the healthcare system itself.

During the 2016 election campaign, many Republican politicians used the idea of “repealing” the ACA to energize their voters, without necessarily clarifying what exactly they wanted to repeal. Should all the aspects of the ACA – from the Medicaid expansion to the new healthcare quality metrics in hospitals –be repealed? If voters relied on the local television news to learn about the ACA, and if this coverage – as is suggested by Gollust’s study – viewed the ACA predominantly as a political entity, then it is not surprising that voters failed to demand nuanced views from politicians who vowed to repeal the law. The research also highlights the important role that television reporting plays in framing the debate about healthcare reform. By emphasizing the actual content of the healthcare reform and its medical implications and by using more scholars instead of politicians as information sources, these media outlets could educate the public about the law.

There are many legitimate debates about the pros and cons of the healthcare reform that are not rooted in politics. For example, electronic medical records allow healthcare providers to easily monitor the results of laboratory tests and avoid wasting patient’s time and money on unnecessary tests that may have been ordered by another provider. However, physicians who are continuously staring at their screens to scroll through test results may not be able to form the interpersonal bond that is critical for a patient-doctor relationship. One could consider modifying the requirements and developing better record-keeping measures to ensure a balance between adequate documentation and sufficient face-to-face doctor-patient time. The ACA’s desire to track quality of healthcare delivery and penalize hospitals or providers who deliver suboptimal care could significantly improve adherence to guidelines based on sound science. On the other hand, one cannot demand robot-like adherence to guidelines, especially when treating severely ill, complex patients who require highly individualized care. These content-driven discussions are more productive than wholesale political endorsements or rejections of the healthcare reform.

Healthcare will always be a political issue but all of us – engaged citizens, patients, healthcare providers or journalists – need to do our part to ensure that this debates about this issue which directly impacts millions of lives are primarily driven by objective information and not by political ideologies.